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Expanding Health Care Affordability for Older Adults and People with Disabilities

March 17, 2022

Medicaid provides health care coverage for 74 million people, including over 7.8 million older adults and people with disabilities who rely on the program for critical benefits like home- and community-based services (HCBS). The enactment of the Affordable Care Act (ACA) extended Medicaid coverage to millions of low-income adults under age 65, lifting people out of poverty and helping to address racial disparities.

The ACA, however, did not change eligibility or program rules for Medicaid financial eligibility for older adults and people with disabilities. States have broad discretion to adjust their Medicaid eligibility criteria to make Medicaid more affordable for older adults and people with disabilities. Advocates in California have had several recent successes in broadening Medicaid eligibility to better align programs with the eligibility criteria used for the Medicaid expansion program and with the affordability principles of the ACA. This issue brief, Expanding Health Care Affordability for Older Adults and People with Disabilities: A Guide for State Medicaid Advocates, discusses these wins in California, describes the laws California enacted to address affordability gaps, summarizes the Medicaid eligibility landscape in states other than California, and offers a sampling of advocacy strategies that advocates can use to expand Medicaid eligibility in their own states.

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